Intensive Care Medicine

, Volume 37, Issue 8, pp 1297–1301

Continuous arterial pressure waveform monitoring in pediatric cardiac transplant, cardiomyopathy and pulmonary hypertension patients

Authors

  • Sarena Teng
    • Division of Critical Care, Department of PediatricsThe Children’s Hospital
  • Jon Kaufman
    • Division of Cardiology, Department of PediatricsThe Children’s Hospital
  • Zhaoxing Pan
    • Research Institute, Department of PediatricsThe Children’s Hospital
  • Angela Czaja
    • Division of Critical Care, Department of PediatricsThe Children’s Hospital
  • Heather Shockley
    • Division of Cardiology, Department of PediatricsThe Children’s Hospital
    • Division of Cardiology, Department of PediatricsThe Children’s Hospital
Original

DOI: 10.1007/s00134-011-2252-y

Cite this article as:
Teng, S., Kaufman, J., Pan, Z. et al. Intensive Care Med (2011) 37: 1297. doi:10.1007/s00134-011-2252-y

Abstract

Purpose

A continuous cardiac output monitor based on arterial pressure waveform (FloTrac™/Vigileo™; Edwards Lifesciences, Irvine, CA) is now approved for use in adults but not in children. This device is minimally invasive, calculates cardiac output continuously and in real time, and is easy to use. Our study sought to validate the FloTrac™ with the pulmonary artery catheter (PAC) intermittent thermodilution technique in pediatric cardiac patients.

Methods

This was a prospective pilot study comparing cardiac output measurements obtained via the FloTrac™ and arterial pressure waveform analysis with intermittent thermodilution. Subjects carried the diagnosis of pulmonary hypertension or cardiomyopathy, or were in the postoperative course after orthotopic heart transplantation.

Results

Enrolled in the study were 31 subjects, and 136 data points were obtained. The age range was 8 months to 16 years. The mean body surface area (BSA) was 1.1 m2. Bland-Altman plots for the mean cardiac outputs of all subjects with a BSA ≥1 m2 showed limits of agreement of −2.7 to 8.0 l/min (±5.4 l/min). Patients with a BSA ≤1 m2 demonstrated even wider limits of agreement (±8.5 l/min). The intraclass correlation for the PAC was 0.929 and 0.992 for the FloTrac™.

Conclusion

There was poor agreement between the PAC and FloTrac™ in measuring cardiac output in a population of children with pulmonary hypertension or cardiomyopathy, or after cardiac transplantation. This is in contrast to adult studies published thus far. This suggests that the utility of the FloTrac™ and measurements obtained from arterial pulse wave analysis in children is uncertain at this time.

Keywords

Cardiovascular monitoringPediatrics

Copyright information

© Copyright jointly held by Springer and ESICM 2011